Long-term outcomes of liver transplantation from elderly donors
Emre Karakaya1, Rengin Erdal2, Adem Safak1, Ozan Okyay1, Sedat Yildirim1, Sedat Boyacioglu3, Adnan Torgay4, Mehmet A. Haberal1.
1Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey; 2Department of Public Health, Baskent University, Ankara, Turkey; 3Department of Gastroenterelogy, Baskent University, Ankara, Turkey; 4Department of Anaesthesiology and Reanimation, Baskent University, Ankara, Turkey
Introduction: Living donor kidney transplantation is still an important alternative since kidney transplantation from deceased donors is not yet at the desired level. On the one hand, efforts are underway to increase the use of deceased donors, while on the other hand, criteria are being expanded to increase the use of living donors. The use of people over 50 years of age as donors is still controversial. In this study, we aimed to investigate the survival rates of recipients after liver transplantation with grafts from donors aged 50 years and older.
Material and Methods: According to our donor evaluation protocol, all living donors are related to their recipients. If there is blood group compatibility and there is no problem in other laboratory tests, the donor is examined by CT angiography (CTA). In living donors, remnant volume must be 40% and above. In addition, graft weight body weight ratio should be at least 1%. Mr cholangiography (MRCP) examines the bile ducts. If no obstacle is found on CTA and MRCP, the donor is consulted preoperatively with the relevant departments. Finally, a liver biopsy is taken from the donor for pathological examination of the liver.
Results: Since 1988, 760 liver transplants have been performed by our team. Of these, 217 were from deceased donors and 543 were from living donors. Furthermore, 388 of these patients were adults and 372 were pediatric. We grouped the recipients according to the age of the donors and then divided these groups into two subgroups as deceased and living donors. After liver transplantation from donors aged 50 years and older, 1-, 5-, 10- and 15-year survival rates in deceased donors were 65, 51, 51 and 40%, respectively. In liver transplants from living donors, the 1-, 5-, 10- and 15-year survival rates were 59, 50, 45 and 45%, respectively.
Conclusion: If a detailed preoperative evaluation is performed in elderly donors, liver transplantation can be performed safely and satisfactory survival rates can be achieved. In particular, graft weight body weight ratio and pathologic evaluation of the graft are vital for survival.
